Systems Change Strategies to Address the Social Determinants of Health Sponsored by Partnership for Better Health and Greater Carlisle Project on April 26, 2017 Presentation & Design by Jason D. Alexander, Principal and Co-Founder Capacity for Change, LLC
Capacity for Change, LLC Capacity for Change, LLC is a public interest consulting firm based in West Chester, Pennsylvania that works with public, philanthropic and nonprofit organizations to create positive and lasting social impact through better strategy, culture and partnership design. Established in 2001 by Jason D. Alexander, MPP, and Meghan McVety, MPA, Capacity for Change has expertise in strategic planning, public-private partnership development, convening facilitation, organizational culture and effectiveness, design thinking for social innovation, social enterprise business planning, the Collective Impact framework, and Diversity, Equity and Inclusion (DEI) initiatives. 2
Better understand the social ★ determinants of health and their impact on individuals and communities Systems Change Strategies Explore systems change ★ to Address the Social concepts, strategies & tools Determinants of Health that can help improve health outcomes and ensure more Learning Objectives equitable access to care Identify and co-create new ★ opportunities to work together to make a collective impact on the health of your community Change the world ★ 3
“We don’t see things as they are, we see them as we are.” – Anais Nin Source: https://personalmasterycoaching.wordpress.com 4
Why Change? Systems Change Strategies to Address the Social Determinants of Health
How Healthy Is South Central Pennsylvania? Cumberland County Perry County Ranks 5th for Health Outcomes in PA Ranks 18th for Health Outcomes in PA ➔ ➔ Health behaviors: Physical inactivity, teen Health behaviors: Adult smoking rates ➔ ➔ births lower than state average lower than state average Clinical care: Uninsurance rates, ratio of Clinical care: Diabetes monitoring rates ➔ ➔ primary care physicians, preventable better than state average hospital stays lower than state average Social & economic factors: HS graduation, ➔ Social & economic factors: HS graduation unemployment, children in poverty rates ➔ rates, some college, children in poverty, better than state average injury deaths better than state average Physical environment: Air pollution above ➔ Physical environment: Air pollution above state average but better over time; severe ➔ state average but better over time; severe housing problems better than average housing problems better than average Source: Robert Wood Johnson Foundation County Health Rankings & Roadmaps www.countyhealthrankings.org 6
29% 2017 Adult Obesity Rate in Pennsylvania Source: Robert Wood Johnson Foundation County Health Rankings & Roadmaps www.countyhealthrankings.org 7
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● Stress ● Inadequate sleep Access to healthy foods (inc. ● Obesity is a complex condition with cost) and nutrition education biological, genetic, behavioral, social, ● Physical inactivity cultural, and environmental ● Food advertising influences. Portion sizes ● Race-ethnicity, gender, age, income, Medical conditions ● and other socio-demographic factors ● Prescription drug use also can play a role in this complex ● Chemical exposure health issue. Maternal pre-pregnancy weight ● status and smoking - Food Research & Action Center ● Adverse Childhood Experiences frac.org/obesity-health/factors-contributing-obesity ● Lack of safe, green spaces for physical activity 9
Obesity, like most public and community health issues, is a complex social problem. See also: Homelessness ❖ Opioid addiction ❖ Mental health stigma ❖ Food insecurity ❖ Unresolved childhood trauma ❖ 10
Complexity of Social Problems Vs. Our Solutions Traditional Approaches > Isolated Impact Large-scale social change Funders select individual grantees ➔ Organizations work separately and ➔ requires broad cross-sector compete Evaluation attempts to isolate a particular ➔ coordination, not the organization’s impact Large scale change is assumed to depend ➔ isolated intervention of on scaling organizations individual organizations. Corporate and government sectors are ➔ often disconnected from foundations and nonprofits Source: Collective Impact by John Kania & Mark Kramer, Stanford Social Innovation Review Winter 2011 www.ssir.org 11
Case Study: Homelessness in Montgomery County PA Before 2014, Montgomery County’s housing crisis response system was… ● Fragmented, duplicative and lacking 464 coordination ● On a “First come, first serve” basis for services ● Primarily based on a Housing Ready philosophy People were literally homeless in ● Rife with silos and side doors ● Not using data to drive decision-making Montgomery County, PA on the night ● Funded through isolated and unaligned public of January 30, 2013. and philanthropic sources ● Hard to access and navigate for the consumer ● Disconnected from health, mental health, child welfare, employment and other public systems Source: Montgomery County Homeless Management Information System 12
Your Way Home Montgomery County PA Systems change resulting in one unified housing ● crisis response system 34% Embrace of housing first approach & strategies ● ● Public-private partnership premised on the Collective Impact framework ● Re-definition of homelessness as a public health Reduction in homelessness from crisis January 2014 - January 2017, ● Five-year funding commitment from County including exit to permanent housing Commissioners through the fee-based AHTF and low return to homelessness rates ● Braided and leveraged federal, state, local and philanthropic funding that meet or exceed national ● Your Way Home Fund to pool contributions that benchmarks fill public funding gaps & build system capacity ● Leadership roles for consumers, providers, funders, landlords and community partners Source: Montgomery County Homeless Management Information System; see also www.yourwayhome.org 13
1. What are the three most challenging health problems facing our region today? Table Talk 2. Of these three, which might better be addressed by taking a collective systems change approach? 14
What Are We Changing? Systems Change Strategies to Address the Social Determinants of Health
Advancing Health Equity, Building Healthier Communities When it comes to improving health, well-being, and equity in America, we often say that we are all in it together. But we as a nation have largely addressed health issues in parallel tracks, with limited cross-sector collaboration. - Risa Lavizzo-Mourey, MD, MBA, former President and CEO, Robert Wood Johnson Foundation 16
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Adverse Childhood Experiences ACEs are adverse childhood experiences that harm children’s developing brains so profoundly that the effects show up decades later; they cause much of chronic disease, most mental illness, and are at the root of most violence. ● Nearly two-thirds (64%) of adults have at least one ● A person w/4 or more ACEs is: ● 12x as likely to attempt suicide ● 10x as likely to use injection drugs ● 7x as likely to be an alcoholic ● 2x as likely to have heart disease, stroke and/or cancer 19 Source: https://acestoohigh.com
Health Equity Healthy People 2020 defines health equity as the “attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.” 20
Health Inequities and Disparities Health inequities are differences in health that are avoidable, unfair, and unjust. Health disparities are differences in health among groups of people. 21
1. What social determinants of health are most likely contributing to the major health problems Table Talk facing our region? 2. Who is most likely to be experiencing health and health care disparities in our region? 22
How Might We Change Our Systems for the Better? Systems Change Strategies to Address the Social Determinants of Health
Everything we do is tied to a coalition in which government, private sector, philanthropy, and nonprofits all come together to build trust, discuss the issue, come to an agreement on what the issue is, and then come up with a strategy to address the issue. - Antonia Hernández, President and CEO of the California Community Foundation. 24
What is Systems Change? A fundamental change in policies, processes, relationships, and power structures, as well as deeply held values and norms, as the pathway to achieve common goals and make positive social gains sustainable at scale, whether it’s around increasing equity, improving health, or reducing poverty. Source: Fostering System Change by Srik Gopal & John Kania, Stanford Social Innovation Review November 2015 www.ssir.org 25
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